Testimony in support of Kendra's Law

Credentials

My name is DJ Jaffe, former NAMI, NAMI NYS and AMI Metro NYC Board Member
Author of their policies on court ordered treatment
Author of articles/op-ends on court ordered treatment (New York Times, National Review, etc.)
Cofounder/(Former) Board Member: Treatment Advocacy Center in Arlington, VA
Testifying in my capacity as cochair of the NY Treatment Advocacy Coalition, a coalition of organizations and individuals that worked to see Kendra’s Law enacted.

Position:

In favor of permanent renewal
• 10 years of testing in NYS (5 year Bellevue project, 5 year AOT) with proven results

• Consumers say it helps:
· 75 percent reported that AOT helped them gain control over their lives;
· 81 percent said that AOT helped them to get and stay well; and
· 90 percent said AOT made them more likely to keep appointments and take medication.

Those who were wrong when Kendra’s Law was enacted, are wrong when they say it should not be renewed.

See oped in April 18th NY Post written by E. Fuller Torrey (enclosed).

He analyzed what the opposition said when Kendra’s Law was first debated, and how every prediction they made turned out to be wrong:

•They said that Kendra's Law would catch "tens of thousands" of people each year in a mental health "dragnet." In fact, an average of only 747 people each year,

• They said that Kendra's Law would destroy the therapeutic relationship. Yet 87 percent of consumers said that they continue to be confident in their case manager's ability to help them.

• They said Kendra's Law would drain fiscal resources from other mental-health programs. In fact, it has markedly reduced many costly services for participants, such as emergency services and hospitalizations, and costs of law-enforcement response time and repeated jailing.

• They said police would come after people with needles. They were wrong.

• The court order didn’t make a difference and the related argument: there was no control group.

To compare a group that won’t accept treatment without an order (noncompliant) to a group that will accept treatment without an order (compliant) is comparing apples and oranges. The law is meant for one, not the other.

• It’s unconstitutional in spite of fact the NYS Courts have decided it is constitutional. No challenge in any state ever succeeded

• It violates civil liberties, in spite of the fact that

• the alternative, inpatient commitment is more restrictive and more expensive, and
• medicines can restore the ability of the brain to function and thereby enable a meaningful exercise of civil liberties and free will. Thinking the FBI put a transmitter in your head is not an exercise of free will, it is imprisonment by psychosis.

• Consumers oppose it in spite of the figures showing they don’t also note suicide went down
• All we need is more community services (in spite of the fact that this group does not access services even when available.

This vocal minority, who see Kendra’s Law as a threat to their own funding, programs and agendas will always be there. But they are a tiny minority, albeit well-funded, mainly by NYS OMH.

When law passed in NY, like in the rest of the country, there was virtually unanimous support for it from across political spectrum:

Republicans and Democrats
Bruno and Silver
Families and Consumers
Spitzer and Pataki
Mental Health Advocates and Community Safety Groups
New York Times
New York Post
Newsday
Daily News
Greater NY Hospital Association
Center for the Community Interest
Victim Services Agency
Visiting Nurses Service
Alliance for the Mentally Ill of New York State
St. Francis Residence
Project for Psychiatric Outreach to the Homeless
NY Society for the Deaf
Concerned Citizens for Creedmoor
The Bridge, Inc.
NY Center for Neuropsychology and Forensic Behavioral Science
NAMI/Buffalo and Erie County
NAMI/Familya (Rockland County)
NYS Public Employees Federation
Treatment Advocacy Center
Schizophrenia.com
National Alliance for the Mentally Ill
And many more

Mental health system before Kendra’s Law didn’t care about mentally ill, only mental “health”

To appreciate Kendra’s Law effect on mental health system, you have to understand how dysfunctional the mental health system was before the law was enacted and what we risk going back to if not renewed.

Before Kendra’s Law, they system failed to differentiate mental health from mental illness.
There was no mental “illness” system, only a mental “health” system.

1-5% of population has the most severe neurobiological disorders, like schizophrenia.

But according to MHA, DMH, OMH, APA, Coalition of MH Providers, NYAPRS, the consumertocracy, etc. who thought the best way to increase their funding was to show greater need, 40%-50% of people have MH problem
NYC DMH report (under Commissioner Jones) defined mental health to include
Lack of housing
Poor grades in school
Discomfort with own sexual identity
Not getting along with parents
Bereavement

State-funded professional consumers decided talking about individuals who were violent as a result of their illness was stigmatizing. So they totally abandoned the seriously ill who were in jail, those who suicided, those in the news. It was like they didn’t exist. It became politically incorrect to talk about them. And still is

Public Interest lawyers:

With thousands of homeless, psychotic in the street, unable to get housing programs to accept them. With thousands more in jails, legal advocacy organizations like NYCLU, NYLPI, NYS CQC, were so delusional, they believed their responsibility was to defend the right of individuals to refuse treatment rather than help increase access.

Providers of Mental "Health" Services:

Money was going to programs that dealt with mental health, not mental illness.
Project Reachout, Fountain House, and a few others were exception, not rule.
Your ability to get help was inversely related to need for it.
The sicker you were, the harder it was to get into a program.
Programs had no authority to facilitate compliance among the non-compliant, so only accepted those who were compliant to begin with. I don’t blame them. I may have done same.
The easiest to treat went to the front of the line.
Ex. Outreach workers hired to help homeless mentally ill were reassigned as bereavement councilors to help people get over trauma of walking down steps after the first WTC bombing
• Ex/ Outreach workers were taken off streets to deal with plane crashes.

Before Kendra’s Law Laws did not reflect current science

Science of mental illness

Before Kendra’s Law, our laws denied new discoveries in the science of mental illness based on brain scans, using PET, SPECT, MRI etc. The most common reason that people with severe mental illnesses are not being treated is that they don’t believe that they are ill. They “know” the FBI planted transmitters in their head, they don’t just “think” it. This lack of insight, a neurological deficit known as “anosognosia,” impairs a person’s ability to recognize that his or her symptoms are caused by a brain disorder. If they do not realize they are ill they will not seek or accept services voluntarily. New York’s Dr. Xavier Amador is the foremost researcher in this area, and I refer you to his work. Before Kendra’s Law, we denied this reality

Science of violence

Numerous studies had been done to answer the question, “Are “the mentally ill” more violent?,

It turns out the answer is, “it depends on who you define as mentally ill?”

If you buy into the MHA, APA, DMH, OMH proposition that 40-50% of the population are mentally ill, and study those, you will come up with the result that they may not be.
But if you study the1%-5% of the population with the most serious forms of mental illness. You clearly find there is an increase in violence among that group if they are not being treated. I know it is politically incorrect to say so, but it is reality. In fact, I think over 30% of NAMI members reported they were attacked at some point by their ill relative.
Those who wanted to prove people with serious mental illness were not violent engaged in other statistical slights of hand
Include 50% of population in study
Dismiss the effect of alcohol or drugs in spite of fact 50% of seriously mentally ill have those problems
Exclude from study of violence those who are in jail, prison, hospitals, or suicided.
Only study those receiving top-notch services

Before Kendra’s Law, we denied this reality.

Results
Riker's Island became the states’s largest psychiatric hospital, 2nd largest in country
Larry Hoag
Andrew Goldstein

Kendra’s Law is not so much about committing the patient to the system. It is much more about committing the system to the patient.

Providers could no longer pick and choose whom they serve
Hospitals could no longer discharge to the crack in the system
Caseworkers would have to focus on the most seriously ill.

Providers were placed under court order to provide treatment.

That is the main benefit of Kendra’s Law. Not only is the individual ordered to accept treatment, the provider is ordered to provide it.

The system is now focusing on the most severely ill
African Americans and Hispanics can now get the kind of services Harvey Rosenthal (no fan of Assisted Treatment) called the “Gold Standard in Treatment” at state hearings on this.

The system is being appropriately reoriented from a focus on mental health to mental illness.

To quote a report by NAMI NYS

AOT has made a critically important contribution to mental health care by making the system more responsible for the most serious cases in the community. Providers can no longer allow people to “fall through the cracks” with impunity.

Historically providers have focused on helping those with insight and a desire to recover, for whom it is naturally much easier to provide care and promote recovery. The subtext of Kendra’s Law is the struggle to shift providers focus to the people who need the most care in the community…”

In conclusion, I would like to submit a chart that compares the state of the mental health system before and after Kendra’s Law. When reviewing that, I don’t see how we can do anything but

Kendra’s Law effect on consumers

Impact on

Before Kendra’s Law

After Kendra’s Law

Civil rights

Non-compliant, dangerous consumers were forced into the most restrictive form of treatment: inpatient commitment.

Now they have a less restrictive community-based option: Assisted Outpatient Treatment

Dangerousness

Law only allowed help after someone became danger

Law helps prevents danger by allowing help before it develops

Expenses

System relied on expensive inpatient hospitalization, incarceration, and inpatient commitment

Consumers access less expensive community based programs and are hospitalized and incarcerated less often.

Prioritization of Resources

Dollars were going to those with less serious illnesses. Ability to access help was inversely related to need

More dollars are now going to those with the greatest need.

Access to care

Programs picked and chose the easiest to treat because they had no mechanisms to ensure compliance

programs more willing to serve those who need it most.

Crack in the system

The crack in the system was the system.

Case management assures continuity of services

Treatment venues

Jail was the only option for the non-compliant

Treatment became an option.

Equal access to care

African Americans and Latinos were discriminated against

African Americans and Latinos are getting access to services

Incarceration*

23%

Reduced 87%

Arrest*

30%

Reduced 83%

Psychiatric hospitalization*

97%

Reduced 77%

Homelessness*

19%

Reduced 74%

Danger to self/suicidal**

9%

Reduced 55%

Alcohol Abuse**

45%

Reduced 49%

Drug Abuse**

44%

Reduced 48%

Suicide threats**

15%

Reduced 47%

Harm to others**

15%

Reduced 47%

Destruction of property**

13%

Reduced 46%

Public disturbances**

24%

Reduced 38%

Verbal assaults**

33%

Reduced 36%

*Percentage of individuals who exhibited these incidents 3 years prior to AOT vs. during period in AOT

** Percentage of individuals who exhibited this behavior three months prior to order vs. after 6 months under order

What is striking is how closely the results parallel those of studies in other states. Studies of AOT across the country have proven it reduces hospitalization, incarceration, dangerousness and increases quality of life for individuals in the program.

The alternative is to go back to using the most expensive, most restrictive form of treatment: inpatient commitment. Let’s not do that. Renew Kendra’s Law. It works.

April 21, 2005

Reduced Incidence of Harmful Behaviors
(Percent of Persons with One or More Events Reported in the Past 90 Days)

At onset of AOT order

At 6 months

Percent reduction in harmful behaviors

Physically Harm Self/Made Suicide Attempt

9%

4%

55%

Abuse Alcohol

45%

23%

49%

Abuse Drugs

44%

23%

48%

Threaten Suicide

15%

8%

47%

Physically Harm Others

15%

8%

47%

Damage or Destroy Property

13%

7%

46%

Threaten Physical Harm

28%

16%

43%

Create Public Disturbances

24%

15%

38%

Verbally Assault Others

33%

21%

36%

Theft

7%

5%

29%

Average Percent Reduction

44%

The information on Mental Illness Policy Org. is not legal advice or medical advice. Do not rely on it. Discuss with your lawyer or medical doctor. Mental Illness Policy Org was founded in February 2011 and in order to maintain independence does not accept any donations from companies in the health care industry or government. That makes us dependent on the generosity of people who care about these issues. If you can support our work, please send a donation to Mental Illness Policy Org., 50 East 129 St., Suite PH7, New York, NY 10035. Thank you. Contact office@mentalillnesspolicy.org Contact DJ Jaffe, founder http://mentalillnesspolicy.org.